DOVER –– A Cancer Incidence and Mortality Report released by the Department of Health and Social Services in cooperation with the Delaware Cancer Consortium Tuesday brought mostly good news about cancer trends across the state.

The 175-page report focused on data from 2008 to 2012 and evaluated eight types of cancer and tracked Delaware’s progress in screening, diagnosis and treatment over the five years.

“Although there are many numbers in the study, none are more important than the all-site cancer mortality rate,” said Rita Landgraf, secretary of Delaware Health and Social Services. “Our cancer mortality rate fell 14 percent between 1998 and the year 2002 and the latest five-year period, 2008 to 2012 which matches the national decline.”

In the 1990s, Delaware’s cancer mortality rate ranked second highest in the nation and by 2015, the state had moved back to the 14th spot.

The big four

Every study released by the Delaware Cancer Consortium includes the four most common types of cancer in Delaware –– breast cancer, colorectal cancer, lung cancer and prostate cancer.

Of the four, lung cancer is the biggest problem –– accounting for 14.4 percent of all new diagnoses and 30 percent of all cancer deaths in Delaware from 2008 to 2012.

It’s the most frequently diagnosed cancer in Delaware and across the United States.

Rita Landgraf

Although lung cancer is still a prominent cancer, there are strides being made among most demographics. Among Delaware males, lung cancer incidence rates decreased 14.1 percent between the Consortium’s 1998 to 2002 report and the 2008 to 2012 report compared to a 15.6 decline among men nationwide. But the incidence rate for Delaware females raised by 6.5 percent while nationally, it decreased by 3.6 percent.

Prostate cancer incidence rates in Delaware, like lung cancer rates, continue to lag behind the national average. Between the 1998 to 2002 report and the 2008 to 2012 report, Delaware’s incidence rate decreased 9 percent while the national rate fell 23.7 percent.

Delaware remains slightly ahead of the national average when it comes to breast cancer mortality –– 126.7 per 100,000 to 124.8 per 100,000, respectively.

Although incidence rates have declined in the state between the 1998 to 2002 study and the 2008 to 2012 study (by 3.4 percent), the rate hasn’t kept up with the national decline of 8 percent in the same time frame.

The most improved of the four cancers has been colorectal. Comparing the 1998 to 2002 report to the 2008 to 2012 report, Delaware’s colorectal cancer mortality rate decreased by 30.5 percent while the national rate decreased by 24.4 percent.

In Delaware, African American males made the greatest strides with their colorectal mortality rates dropping by 49.7 compared to the 29.3 percent decrease among their Caucasian counterparts.

Cancer screenings

One of the main contributors to reduced cancer deaths in both Delaware and the nation can be attributed to increased cancer screening, especially for the big four.

“We’re excited that we’ve made great strides with cancer screenings,” Dr. Rattay said. “We are grateful for our partners in this because lives are being saved.”

Screenings aren’t helpful simply because they can detect cancer, they can detect cancer in its early stages, making treatment more effective and successful.

Before 2013, there were no lung cancer screenings recommended by the American Cancer Society so between 2008 and 2012, 53.6 percent of Delaware lung cancer cases and 53.4 percent of U.S. lung cancer cases were diagnosed in the distant stage.

Distant stages include cases where the cancer has spread from the primary site to surrounding tissues, organs or lymph nodes.

Starting in 2015, the Division of Public Health’s Screening for Life Program debuted –– covering a low-dose CT scan for early detection for lung cancer. The screening is available to current and former smokers deemed at high risk for lung cancer.

The program is intended to increase the survival rate of those diagnosed with lung cancer.

Due to increased screening rates for breast cancer –– Delaware now has the third highest breast cancer screening rate in the country –– the number of early detections for breast cancer have been rising since the 1980s.

In a 1980 to 1984 study, 42.2 percent of breast cancer cases were caught in the local stage while in the 2008 to 2012 report, the statistic was 65.1 percent thanks to more than 80 percent of Delaware women aged 40 and older having a mammogram within the past two years.

Delaware ranked fifth highest in the U.S. for colorectal cancer screening and according to the 2014 Behavioral Risk Factor Survey, 77 percent of Delawareans age 50 and older reported having had a colorectal cancer screening including a sigmoidoscopy or colonoscopy.

“We are indeed making big improvements but we still have a long way to go,” Sec. Landgraf said.

Cancer prevention

“Our first priority as public health officials is to of course, prevent the disease of cancer,” Sec. Landgraf said.

The most well known preventative measure to reduce the risk of cancer is to quit using tobacco in all forms. According to the U.S. Department of Health and Human Services, 85 to 90 percent of all lung cancer cases can be attributed to tobacco use.

According to the Centers for Disease Control and Prevention, tobacco-related lung cancer costs Delaware approximately $722 million per year in direct medical expenditures and indirect productivity loss

Despite rates of tobacco use falling, alternatives like e-cigarettes, remain a concern of health care professionals.

Use of e-cigarettes among Delaware high school students jumped from 2.1 percent in 2012 to 23.5 percent in 2015 and 40.5 had at least tried e-cigarettes.

“Secondhand vapor from e-cigarettes still contains dangerous carcinogens and the vapor can aggravate those with respiratory conditions like asthma and COPD,” said Dr. Karyl Rattay, director of the Division of Public Health.

Cutting out tobacco may seem like a no-brainer when it comes to cancer prevention but Dr. Rattay said people typically discount the importance of healthy lifestyle choices like diet and exercise in cancer prevention.

“Many Delawareans are aware that by eating healthier and drinking healthier, we can improve our health and some of the most important things we can do are eat more fruits and vegetables and eat a high fiber diet,” Dr. Rattay said. “It’s also important that we reduce our intake of sugar-sweetened beverages.”

Sugar isn’t only associated with becoming over weight or obese –– major risk factors for cancer –– Dr. Rattay said there is ever-growing evidence of a relationship between sugar-sweetened beverages and various types of cancer.

In addition to adopting a healthy diet, Dr. Rattay stressed the importance of physical activity not only to maintain a healthy weight but to reduce the risk of cancer too.

“People aren’t aware of the link between physical activity and cancer although we’ve known for quite some time that there is a relationship between physical activity and colorectal cancer,” she said. “But now there’s growing evidence of a relationship between physical activity and breast cancer, lung cancer and even endometrial cancer.”

For more information about cancer or to view the Cancer Incidence and Mortality Report, visit dhss.delaware.gov/dph/dpc/cancer.html.